Clinicoepidemiologic features of chronic spontaneous urticaria in patients with elevated plasma D-dimer levels versus those without it: A case-control cross-sectional study of 100 indian patients

• Published in: Indian Dermatology Online Journal Vol. 10; no. 6; pp. 632 - 638
• Main Authors: Chauhan, Shailja, Mahajan, Vikram, Mehta, Karaninder, Yadav, Rajinder, Chauhan, Pushpinder, Bhushan, Satya, Sharma, Vikas, Sharma, Anuj, Wadhwa, Dhaarna, Sharma, Aditi
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01.11.2019; Medknow Publications and Media Pvt. Ltd; Wolters Kluwer - Medknow; Wolters Kluwer Medknow Publications
• Subjects: activated partial thromboplastin time; angioedema; Blood coagulation factors; Care and treatment; Clopidogrel; coagulation cascade; d-dimer; extrinsic coagulation pathway; Health aspects; Medical research; Medicine, Experimental; Omalizumab; Original; prothrombin time; Tranexamic acid; Urticaria; urticaria activity score; India; angioedema; Activated partial thromboplastin time; coagulation cascade; urticaria activity score; urticaria; D-dimer; prothrombin time; extrinsic coagulation pathway
• ISSN: 2229-5178; 2249-5673
• DOI: 10.4103/idoj.IDOJ_505_18

Background: Activated coagulation cascade is implicated in urticaria pathogenesis marked by high plasma D-dimer, a marker of fibrinolysis, levels correlating with high urticaria activity score (UAS) and poor therapeutic outcome. Methods: Quantitative plasma D-dimer levels and coagulation parameters in 100 (male:female ratio 1:3) Indian patients with chronic spontaneous urticaria and age- and gender-matched healthy controls were compared. The clinicoepidemiologic features of chronic urticaria were then compared among patients with normal (≤0.2 mg/L) and elevated (≥0.3 mg/L) plasma D-dimer levels. Results: Plasma D-dimer in 23% patients and 4% controls and prothrombin time and activated partial thromboplastin time in 63% and 5% patients, respectively, were significantly higher compared with 58% and 1% of controls, respectively. About 18 of 72 (25%) patients with high UAS of ≥16-42 were compared with 5 of 28 (17.8%) patients with UAS7 of ≤15. Patients with elevated plasma D-dimer levels had significantly more systemic symptoms (86.9% vs. 81.8%) compared with patients with normal plasma D-dimer levels. Conclusion: A subset of patients with chronic urticaria have elevated plasma D-dimer levels and exhibit higher UAS7 and systemic symptoms that may influence long-term prognosis and therapeutic choices. Small number of patients, a cross-sectional nature of study, lack of treatment outcome measures, information on self-medication, and unavailability of specific parameters for coagulation pathway activation remain few limitations of this study.